A case of multiple metastatic gastric cancer with primary lesion vanished after administrating nivolumab, and the effect
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CASE REPORT
A case of multiple metastatic gastric cancer with primary lesion vanished after administrating nivolumab, and the effect remains even after discontinuance of therapy Hirofumi Doi1 · Motoki Ninomiya2 · Kazuhiro Toyota1 · Satoshi Hirahara1 · Yuta Kuhara1 · Kenji Shirakawa1 · Raita Yano1 · Hironori Kobayashi1 · Yasushi Hashimoto1 · Yujiro Yokoyama1 · Yoshihiro Sakashita1 · Katsunari Miyamoto1 Received: 9 March 2020 / Accepted: 7 July 2020 © The Japan Society of Clinical Oncology 2020
Abstract Nivolumab is one of the immune checkpoint inhibitors available for chemotherapy-resistant gastric cancer. There have been few reports of confirmed prominent shrinkage of the primary tumor and some reports of prolonged antitumor effect after discontinuance of the drug, but it is not universal. A 67-year-old male was admitted to our hospital and diagnosed with metastatic gastric cancer that had spread to the bilateral lobe of the liver, distant lymph nodes, and peritoneum. He received five courses of S-1 plus oxaliplatin, followed by three courses of ramucirumab plus paclitaxel leading to disease progression. Then, the patient was administered nivolumab as third-line therapy. Tumor size was markedly reduced after three courses, esophagogastroduodenoscopy (EGD) revealed scar formation on the lower gastric corpus after seven courses, and biopsy specimen showed no malignancy. When a slight lower limb muscle weakness manifested, possibly an immune-related adverse event (irAE) after 15 courses, we stopped administration of nivolumab. The patient has survived for 26 months since his first visit, and elimination of the primary tumor and ascites with noted shrinkage of liver and lymph node metastases have followed for more than 10 months since discontinuance of nivolumab. Keywords Gastric cancer · Nivolumab · Complete response · Prolonged effect · Double cancer
Introduction Nivolumab was approved for gastric cancer in Japan in 2017. Its disease control rate (DCR) against unresectable gastric cancer was 40.3% (0% of complete response, 11% of partial response, 29% of stable response) in ATTRACTION-2 trial [1]. Two-year additional update data showed three patients (1.1%) with complete response (CR) [2]. Shrinkage of gastric cancer is rarely reported in spite of its fairly high DCR. Antitumor effect after discontinuation of nivolumab has been observed in various cancers [3–5]. But it is unclear * Hirofumi Doi [email protected] 1
Department of Surgery, Hiroshima Memorial Hospital, 1‑4‑3, Honkawa‑cho, Naka‑ku, Hiroshima‑shi, Hiroshima‑ken, Japan
Digestive Disease Center, Hiroshima Memorial Hospital, 1‑4‑3, Honkawa‑cho, Naka‑ku, Hiroshima‑shi, Hiroshima‑ken, Japan
2
when to stop administrating nivolumab if CR was obtained. In addition, it is indistinct how long the antitumor effect continues after discontinuation. Herein, we reported a case of multiple metastatic gastric cancer with primary lesion that vanished after administrating nivolumab, and the effect remains even after discontinuance of the therapy.
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